Facing skyrocketing agency rates, long-term care providers have taken it upon themselves to launch in-house agency services to meet an increasing demand for flexibility among a dwindling number of staff.
Operators market the business line as the “best of both worlds,” Eileen Caffey told Skilled Nursing News – additional pay, experience in different care settings and the stability and benefits that come with working for one organization, are among the perks.
Caffey is the director of recruiting for St. Louis, Missouri-based Bethesda Health Group.
Bethesda created its contingency nurse program at the end of last year as a way to attract people to the organization and think about their staffing model in a different way, she said.
On the management side, Caffey added, in-house agency staff is less expensive than traditional agency use and a “game changer” when regular staff calls off.
“Obviously like a lot of long-term care facilities, we have seen our spend for agency nurses increase not only because we have a greater need, but also because the prices for those nurses continues to go up astronomically from what we’re used to paying,” Caffey added.
Nonprofit Georgia operator A.G. Rhodes is also in the process of creating its own in-house staffing pool to curb costs, with the new business line expected to launch at the beginning of its next fiscal year in June.
A.G. Rhodes CEO Deke Cateau said his organization currently pays agency staff three to four times more than they’re able to pay their own staff.
“This is something we had been talking about for quite some time,” Cateau added. “There’s a lot of what I call price gouging going on with staff agencies … our best way to control that would be to bring that staffing in-house.”
Staff pool expansion
Bethesda’s contingency nurse program works well with its six skilled nursing facilities, with some located in the St. Louis metro area and others in Illinois, according to Caffey.
Caffey hired 12 licensed practical nurses (LPNs) initially, as it is the most expensive position Bethesda gets through outside agencies – Bethesda doesn’t use agency registered nurses (RNs). About 20 certified nursing assistants (CNAs) and a contingency staffing coordinator are next for the program, Caffey noted.
LPNs were the “lowest hanging fruit,” Caffey said, when the organization was discussing its contingency nurse program, but they had to be licensed to practice in both states.
“We’re now up to speed and we are, you know, able to schedule them across our facilities as needed and it’s worked out really well,” Caffey said. “We have been able to hire nurses back who left us to go for an agency opportunity so that was really exciting.”
Cateau said A.G. Rhodes’ staffing pool is contingent on how many open positions and agency workers they currently use. If the nonprofit were to launch the business line today, they’d initially take on 12 professionals between CNAs and LPNs since that is the number of agency staff in use between its three campuses.
Another senior care operator, Indiana-based Majestic Care, grew its own in-house staffing agency to more than 60 full-time professionals in six months. More than half of its agency staff are CNAs, followed by LPNs and 10-15% being RNs.
“They commit to travel responsibilities and go where the need is within a certain mileage,” Bernie McGuinness, CEO of Majestic Care, said. “There’s enhanced rates of pay if they do go outside a certain 50 mile radius to be able to meet the needs of our facilities.”
Currently, Majestic Care is focused on growing its floater pool in four markets: Fort Wayne, Indiana, as well asDetroit, Livonia and Flint in Michigan. Its agency staff also travel to Indianapolis as well as Columbus and Cincinnati, Ohio, McGuinness said.
“We’ve really done a heavy campaign … targeting nurses throughout the Midwest, with some enhanced pay rates,” McGuinness added. “We’ve heard from our [LPNs] especially and we’ve changed some of those pay rates; we’ve seen some success especially in the Cincinnati market.”
Bethesda was able to bring on new LPNs through the program that would have otherwise applied for a traditional long-term care opportunity at the organization.
“Why do they like agency? Obviously, they like to get paid more, but a lot of it is also the flexibility to be able to have more control over their schedule,” Caffey said. “They also tend to like the idea of moving around, going into different care settings and having the opportunity to develop their skills, perhaps across multiple different specialties in multiple different facilities.”
Caffey said her agency staff would not get canceled at the last minute if not needed, a common frustration among workers at traditional staffing agencies.
“They would also know very well and receive training on our electronic medical record system, on our policies, on our equipment, so that they have a certain level of comfort,” Caffey added. “As a [traditional] agency nurse, you’re dropped in with limited training and are expected to make it work.”
Multiple, specialized care settings
That’s one of the main reasons why Bethesda is being more selective with staff to fill these floating roles – they need to be more experienced in a multitude of different settings for the model to work well.
A good program candidate would be able to “drop into any setting and be successful” with Bethesda’s contingency nurse training. Others Bethesda felt weren’t quite ready for the program were hired full-time dedicated to one location, Caffey said.
Cateau said the makings of an in-house staffing agency coincides with the nonprofit’s mission of person directed care, with an emphasis on dementia and memory care settings.
“We want to be able to provide the type of care to our homes that is seamless,” Cateau said. “Similarly, we want to be able to staff our homes in any emergency situation or any temporary situation with staff that are trained on person directed care and trained on taking care of individuals living with dementia.”
An East Coast continuing care retirement community (CCRC) said it is currently weeks away from launching its equivalent of a staffing agency as well, echoing Caffey and Cateau regarding flexibility for its staff
The organization chose not to be named until its service officially launches.
Working out agency logistics
Lori Porter, CEO of the National Association of Health Care Assistants (NAHCA), said operator-grown staffing agencies and float pools need to be cognizant of travel logistics and staff demographics.
“We know the demographic of CNAs is primarily women, primarily single mothers, primarily poor, not a good working car, maybe not good childcare … that travel distance, they may or may not be able to do that,” Porter said.
Cateau is also still discussing workers’ compensation, liability and insurance implications for the planned separate business and the existing business lines with leadership at A.G. Rhodes, other logistics issues that need to be ironed out before the nonprofit launches their staffing pool in June.
“We are currently speaking with our attorneys, speaking with the insurance folks … that’s a very thin line that you walk, because you got to make the appropriate benefit distinctions while following appropriate labor and benefit laws under the Affordable Care Act,” Cateau said.
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